Retinal metabolic and structural alterations in response to aflibercept treatment in neovascular age-related macular degeneration

Ditte B. Jakobsen, Thomas L. Torp, Einar Stefansson, Tunde Peto, Jakob Graussland

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Abstract

Purpose Non-invasive retinal markers of disease activity could pave the way for individualized treatment in neovascular age-related macular degeneration (nAMD). We aimed to evaluate if retinal vascular oxygen saturation and calibres could predict the initial treatment response after a loading phase of intravitreal aflibercept in nAMD. Method A total of 149 eyes were included (nAMD, n=76; dry AMD, n=30; normal eyes n=43). Of these, 57 treatment-naïve eyes with nAMD received three monthly injections with 2.0 mg aflibercept and were subsequently stratified according to functional and structural response according to development in best-corrected visual acuity and macular retinal thickness. The retinal vascular oxygen saturation and calibres were measured prior to treatment and one month after the third injection. Results Patients with nAMD and dry AMD had higher retinal arteriolar oxygen saturation as compared to normal eyes (94.3% vs. 95.2% vs. 92.6%, p=0.04). Thirty-nine (68.4%) and 12 (21.1%) eyes with nAMD were functional and structural responders. After the loading phase, structural non-responders developed a higher retinal arteriolar (95.3% vs. 93.3%, p=0.03) and venular (64.7 vs. 59.4%, p=0.02) oxygen saturation, and responders developed a lower retinal arteriolar calibre (118.0µm vs. 114.3µm, p<0.01). In a multiple logistic regression model, increasing retinal venular oxygen saturation associated with a negative treatment outcome (odds ratio 1.17 for each 1% increment, 95% confidence interval 1.01-1.36, p=0.03). Conclusion Changes in the retinal venular oxygen saturation associate independently with initial treatment response in nAMD, but functional and structural retinal measurements prior to treatment could not predict the treatment response.
Original languageEnglish
Number of pages7
JournalActa Ophthalmologica
Early online date13 Dec 2018
Publication statusEarly online date - 13 Dec 2018

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